Predictors of early death in a cohort of Ethiopian patients treated with HAART

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Abstract

Background: HAART has improved the survival of HIV infected patients. However, compared to
patients in high-income countries, patients in resource-poor countries have higher mortality rates.
Our objective was to identify independent risk factors for death in Ethiopian patients treated with
HAART.

Methods: In a district hospital in Ethiopia, we treated adult HIV infected patients with HAART
based on clinical and total lymphocyte count (TLC) criteria. We measured body weight and
complete blood cell count at baseline, 4 weeks later, then repeated weight every month and
complete blood cell count every 12 weeks. Time to death was the main outcome variable. We used
the Kaplan Meier and Cox regression survival analyses to identify prognostic markers. Also, we
calculated mortality rates for the different phases of the follow-up.

Results: Out of 162 recruited, 152 treatment-naïve patients contributed 144.1 person-years of
observation (PYO). 86 (57%) of them were men and their median age was 32 years. 24 patients
died, making the overall mortality rate 16.7 per 100 PYO. The highest death rate occurred in the
first month of treatment. Compared to the first month, mortality declined by 9-fold after the 18th
week of follow-up. Being in WHO clinical stage IV and having TLC<= 750/mcL were independent
predictors of death. Haemoglobin (HGB) <= 10 g/dl and TLC<= 1200/mcL at baseline were not
associated with increased mortality. Body mass index (BMI) <= 18.5 kg/m2 at baseline was
associated with death in univariate analysis. Weight loss was seen in about a third of patients who
survived up to the fourth week, and it was associated with increased death. Decline in TLC, HGB
and BMI was associated with death in univariate analysis only.</p>

Conclusion: The high mortality rate seen in this cohort was associated with advanced disease
stage and very low TLC at presentation. Patients should be identified and treated before they
progress to advanced stages. The underlying causes for early death in patients presenting at late
stages should be investigated.